DR Ketut - Interventional Pain Management
DR Ketut - Interventional Pain Management
DR Ketut - Interventional Pain Management
DAMAGE . (Hof
Key word AROLD MERSKEY )
pain is unpleasant
unpleasant sensory and emotional
experience (rasa yg tdk menyenangkan sensorik dan emotional
emotional)).
Associated with actual tissue damage (Acute
(Acute Pain =Nociceptive
pain)
Due to potential
potential tissue damage (Nociceptive pain = Physiological pain =
withdrawal Reflex)
Described in term of such damage (digambarkan seperti adanya
kerusakan jaringan .(
.(tapi tidak)) chronic pain .
tapi tidak
1. Nociceptive Pain
• NYERI NOSISEPTIF ADALAH NYERI
YANG TERJADI AKIBAT ADANYA
SUATU STIMULUS KUAT (MEKANIK,
TERMAL ATAU KIMIAWI) PADA
JARINGAN YANG INTACT (UTUH).
• JADI ADA POTENTIAL TISSUE
DAMAGE YANG MENGHASILKAN
WITHDRAWAL REFLEX.
• BELUM ADA KERUSAKAN
JARINGAN.
• GUNAYA SEBAGAI ALAT
PROTEKSI TUBUH DARI BERBAGAI
KERUSAKAN.
Nociceptive pain
Minimal tissue damage
Sebenarnya pembedahan dimulai dgn nyeri nosiseptif nyeri akut nyeri i
sembuh nyeri hilang, kalau sembuh tapi nyerinya menetap nyeri kronik
Mekanisme Nyeri Nosiseptif atau Nyeri Akut
Diantara simulus noksius dan persepsi ada 5 proses yg Persepsio
tersendiri yaitu; Nosisepsi (respons saraf terhadap stimulus noksius) n
1. Transduksi
2. Konduksi Neuron III
3. Modulasi
4. Transmisi
5. Persepsi
Transduction
Mechanical
Conduction
Transmissio
Action potential n
Modulation
Neuron II
Thermal
Neuron I
Transmission
Chemical
Modified by AHT
CHRONIC PAIN IS DESEASE
CHRONIC PAIN
CHRONIC PAIN IS A PAIN THAT PERSISTS
BEYOND NORMAL TISSUE HEALING TIME,
WHICH IS ASSUMED TO BE THREE – SIX
MONTHS.
• CERVICOGENIC HEADACHE
• MSK PAIN
RVENTIONAL PAIN MANAGEMENT • ACUTE LOW BACK PAIN & NECK PAIN WITH
RADICULOPATHY
2. PERCUT. VERTEBROPLASTY
3. SPINAL CORD STIMULATION
4. SPINAL ENDOSCOPY
Every thing I do is to help you
avoid surgery”
OUR WELL BEING, IS ONLY FREEDOM FROM PAIN” ( DE
MONTAIGNE.1592)
ERDOSSI 2002
25 % HOSPITAL VISIT • PAIN CLINIC RSU KERTHA USADA
PAIN MANAGEMENT
CHRONIC PAIN (POST HERPES NEURALGIA)
ACUTE PAIN (FR CRURIS )
COIN ON THE SAND
AS A SNIPER NOT A BOMBER
LOST IN SPACE
MUSCULOSKELATAL
NERVE ENTRAPMENT
SPINE PROBLEM
CHEPALGIA
CANCER PAIN
MUSCULOSKELETAL
INJECTION
RADIO FREQUENCY ABLATION
NERVE ENTRAPMENT SYNDROME
NERVE NAME
• GREAT OCCIPITAL NERVE • CERVICO GENIC CHEPALGIA
• SUPRASCAPULAR NERVE • SUPRASCAPULAR NERVE ENTRAPMENT
• PUDENDAL NERVE • PUDENDAL NERVE ENTRAPMENT
• ABDOMINAL CUTANEUS NERVE • ABDOMINAL NERVE ENTRAPMENT SYNDROME
• SCIATIC NERVE • PIRIFORMIS SYNDROME
BACK PAIN
• DISCOGENIC PAIN
• FACET JOINT
• SI JOINT
• HNP
LUMBAL FACET
USG
ATIPICAL FACIAL PAIN
TRIGEMINAL NEURALGIA
LUMBAL FACET
USG
STEVE JOBS 1955
1955--2011
COMMON SYMPATHETIC BLOCKS
• SPHENOPALATINE GANGLION
• STELLATE GANGLION
• THORACIC SYMPATHETIC CHAIN
• CELIAC PLEXUS
• LUMBAR SYMPATHETIC
• SUPERIOR HYPOGASTRIC PLEXUS
• GANGLION OF IMPAR
SUMMARY